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On the Third Hand: Tourniquet

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An insurance actuary who has the misfortune to have relatively low-cost, unsubsidized medical insurance that complies with the Patient Protection and Affordable Care Act (PPACA) e-mailed me the other day to ask why she was so miserableWhy were her out-of-pocket costs were so high?

She (many details altered here to protect privacy) had just gone to an in-network hospital with a broken leg and came away with $5,000 in out-of-pocket bills.

Under her old plan, maybe she would have had $1,000 in bills.

She was arguing that those horrible bills were evidence of how PPACA has failed.

My argument would be that, however the many PPACA rules and programs might fail in other ways, any PPACA changes that pile as much of society’s health care market “skin in the game” on readers of — and anyone else who knows what a senate floor is or why someone might care about a health insurance policy’s lifetime out-of-pocket maximum — are good changes. Those are signs that something in PPACA worked properly.

On the one hand, PPACA is more like a tourniquet that tries to keep the uninsured from bleeding to death than any other kind of acceptable solution. I personally dread the thought of having to deal with PPACA exchange coverage, or any other affordable, PPACA-compliant coverage, just as I dread the idea of having to subsist on MREs after a natural disaster.

On the other hand, we’re in this mess partly because our old solution to the gap between what our conscience demands and our actual generosity was to put poor people and sick people in a health care access lottery, with their ability to get any kind of acceptable care depending on the whims of doctors, hospitals and fate.

Most of us reading this have been getting gourmet-level care. Some of the hard working people who serve us meals at restaurants and work the cash registers at the store might have gotten gourmet-level care “for free,” or at least MRE-level care “for free,” but some got no care, or worse care than we’d want for our cats and our dogs. 

We here have at least a general idea of how the health care system works, and ways we could persuade Congress, federal agencies, state legislatures, state agencies, and insurance companies to change it. It seems a lot more reasonable to inflict the pain caused by health care system dysfunction on the people who have the ability to change the system, rather than people who just do what they can to get by.

On the third hand, one of the factors limiting our generosity is our economic productivity. If we somehow design our health finance system in such a way that it limits growth, stops growth or reverses growth, that won’t be good for our ability to have a generous health finance system. The best medicine for a sick health care market is a strong economy. 

Having actual and potential system changers deal directly with health care system dysfunction may be the ideal way to get the system to change. And, one message we system changers need to get is that, if the cost of the current system is so high that shifting the cost into the checking accounts of people with checking accounts impoverishes us, the cost is just plain too high. It doesn’t matter how nice we are or how much we want everyone to get great care.

At this point, with the way things work now, we can barely afford moldy MRE care. If we don’t change our ways, maybe we’ll find all we can really afford is the health care equivalent of eating our old shoes.

See also: On the Third Hand: HSAs


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